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Hiatal Hernia

The hiatus is an opening in the diaphragm through which the esophagus passes. The diaphragm is a wall of muscle that separates the thoracic (chest) cavity from the abdominal cavity. When the stomach protrudes up through the hiatus and into the chest cavity, this is referred to as a hiatal hernia.

There are two types of hiatal hernias:

Sliding hiatal hernia: A sliding hiatal hernia occurs when part of the stomach and the junction between the esophagus and the stomach bulge up through the hiatus and into the chest cavity.

Paraesophageal hernia: A paraesophageal hernia occurs when the junction between the esophagus and the stomach stay in place, but a part of the stomach bulges up through the hiatus and into the chest cavity. Paraesophageal hernias are rarer and also can cause more serious health complications.

Symptoms of Hiatal Hernia

Sliding hiatal hernias tend to be smaller, and typically do not cause any symptoms. Paraesophageal hernias and larger sliding hiatal hernias can cause symptoms like:

Gastroesophageal reflux disease (GERD)

Chest pain

Abdominal pain

Bloating

Regurgitation of food and liquids from the stomach

Shortness of breath

Paraesophageal hernias are more likely to lead to health complications. if left untreated or if larger in size, paraesophageal hernias can cause:

Ischemia: Ischemia is characterized by a loss of blood to the stomach.

Incarceration: A hernia becomes incarcerated when the portion of the stomach that bulges up through the hiatus gets stuck.

Causes of Hiatal Hernia

Possible causes of a hiatal hernia include:

Being born with a hiatal opening that is larger than normal

Pressure on the stomach caused by pregnancy or obesity

Individuals who may have an increased risk of developing a hiatal hernia include:

Women

Individuals over the age of 50

Individuals who are overweight or obese

What to Expect at Your Appointment

During your appointment, your doctor will ask you to describe your symptoms and any changes in your symptoms over the past few months or years, as well as to provide a complete medical history. If your doctor suspects that you have a hiatal hernia, he/she will prescribe diagnostic tests in order to make an accurate diagnosis. Tests used to identify a hiatal hernia include:

Barium swallow test: A barium swallow test is an x-ray scan performed after the patient drinks a liquid containing barium sulfate. The barium mixture coats the esophagus and the hernia, which makes these structures show up more prominently on an x-ray image. These images allow physicians to identify a hernia and determine its size.

Endoscopy: An endoscopy is a procedure that uses a special instrument, called an endoscope, to see the inside of the esophagus. An endoscope is a flexible tube with a camera on the end that is inserted through the mouth and down to the esophagus.

Non-Surgical Treatments for Hiatal Hernia

If a hiatal hernia does not cause any symptoms, there may be no need for treatment. Most likely, caretakers will want to monitor the hernia for any changes. However, if the hernia is symptomatic, symptoms can be managed using medications.

Medications that can be used to treat symptomatic hernias include:

Antacids for the relief of acid reflux

Medications that reduce acid production in the stomach

Certain lifestyle changes can also help to relieve symptoms of hiatal hernias, such as:

Losing weight

Avoiding acidic foods

Eating smaller food portions

Quitting smoking

Reducing the amount of fried and fatty foods from the diet

If a hernia is causing serious health complications, surgical repair may be necessary.

Surgical Treatment for Hiatal Hernias and Post-Treatment

When necessary, surgery is used to return the stomach to its natural position and eliminate symptoms caused by a hiatal hernia. Surgical repair of a hiatal hernia can oftentimes be completed using minimally invasive techniques, which typically only require patients to stay in the hospital for recovery for one to two days. In some cases, patients may be required to follow a liquid diet immediately after surgery, before transitioning slowly to a soft foods diet, and then eventually, to normal eating habits.